Organization Active NPI

Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
National Provider Identifier
1104337120
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
IVYREHAB MICHIGAN, LLC
Practice address
400 Rounds Dr
Fenton, MI 48430-1724
Phone
(810) 750-1996
Fax
(810) 750-6361
NPI assigned
Oct 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ashley Griffiths
Title
Sr. Director of Provider Relations
Phone
(914) 294-4050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081S0010X Primary

Addresses

Primary practice location

400 Rounds Dr
Fenton, MI 48430-1724

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180123001245 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6901165893 Receives reassigned benefits from 334 practitioners

National Provider Directory

National Provider Directory
Tax ID family
Ivyrehab Michigan LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations (25 of 51)

6741 Fulton St E
#201
Ada, MI 49301
Phone (616) 288-2210

540 Main St
Belleville, MI 48111
Phone (734) 489-6440

404 Perry Ave
Ste B
Big Rapids, MI 49307
Phone (231) 753-1236

30100 Telegraph Rd
Ste 140
Bingham Farms, MI 48025
Phone (248) 385-0030

740 W Grand River Ave
Brighton, MI 48116
Phone (810) 227-3588

44560 Ford Rd
Canton, MI 48187
Phone (734) 680-8780

42727 Ford Rd
Canton, MI 48187
Phone (734) 418-4866

7822 Andersonville Rd
Clarkston, MI 48346
Phone (248) 684-9610

16071 15 Mile Rd
Clinton Township, MI 48035
Phone (586) 981-1086

2000 E Oakley Park Rd
Ste 101
Commerce Township, MI 48390
Phone (248) 387-5200

1161 E Clark Rd
Ste 360
Dewitt, MI 48820
Phone (517) 507-5525

7007 Dexter Ann Arbor Rd
Dexter, MI 48130
Phone (734) 680-8800

23330 Farmington Rd
Farmington, MI 48336

4455 24th Ave
Ste 150
Fort Gratiot, MI 48059
Phone (248) 232-0905

11407 S Saginaw St
Grand Blanc, MI 48439
Phone (810) 242-6588

1264 Plainfield Ave NE
Grand Rapids, MI 49505
Phone (616) 888-7993

12319 Highland Rd
Hartland, MI 48353
Phone (248) 255-5832

437 Butternut Dr
Holland, MI 49424
Phone (616) 355-3022

846 E Grand River Ave
Unit B
Howell, MI 48843
Phone (517) 672-5777

7559 36th Ave
Hudsonville, MI 49426
Phone (616) 369-0440

1077 N Wisner St
Jackson, MI 49202
Phone (517) 336-3055

5460 Gull Rd
Ste F
Kalamazoo, MI 49048

3282 Stadium Dr
Kalamazoo, MI 49008
Phone (269) 375-1400

6947 W Q Ave
Kalamazoo, MI 49009
Phone (269) 447-1560

7119 W Q Ave
Kalamazoo, MI 49009
Phone (269) 447-1560

Practitioners & affiliated clinicians

Practitioners 492

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 492

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1104337120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROUNDS DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301724",
            "telephone_number": "810-750-1996",
            "fax_number": "810-750-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB MICHIGAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A",
        "authorized_official_last_name": "GRIFFITHS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PROVIDER RELATIONS",
        "authorized_official_telephone_number": "914-294-4050"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.